Introduction

Uses for Triazolam

Insomnia

Decreases sleep latency, increases the duration of sleep, and decreases the number of nocturnal awakenings.a

Slideshow: Need To Catch Some Shut-Eye? Tips on Getting the Sleep You Need

Has been used for the prevention or short-term treatment of transient insomnia associated with sleep-wake schedule changes† (e.g., rapid travel across time zones [“jet lag”], rotating shift work). May be useful for this purpose in some patients; however, consider the possibility of transient impairment of cognitive function (e.g., anterograde amnesia [“traveler’s amnesia”]). (See Amnesia under Cautions.)

Triazolam Dosage and Administration

General

Use only when able to get 7–8 hours of sleep before being active again.a

Write prescriptions for short-term (7–10 days) use only; the quantity dispensed to the patient should not exceed a 1-month supply.100121a

Reevaluate patient if triazolam is to be used for more than 2–3 weeks.100121a

Avoid abrupt discontinuance in patients who have received prolonged therapy (because of potential for precipitating withdrawal manifestations);100 after therapy with more than the lowest dose for longer than a few weeks, taper dosage gradually, particularly in patients with a seizure history.100

Cautions for Triazolam

Contraindications

Known hypersensitivity to benzodiazepines or any ingredient in the formulation.a

Warnings/Precautions

Warnings

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm; avoid use of benzodiazepines as hypnotics during pregnancy.ac If used during pregnancy or if patient becomes pregnant, apprise of potential fetal hazard.ac

Adequate Patient Evaluation

Insomnia may be a manifestation of an underlying physical and/or psychiatric disorder; carefully evaluate patient before providing symptomatic treatment.a

Failure of insomnia to remit after 7–10 days of treatment, worsening of insomnia, or emergence of new abnormal thinking or behavior may indicate the presence of an underlying psychiatric and/or medical condition.a

Complex Sleep-related Behaviors

Potential risk of complex sleep-related behaviors such as sleep-driving (i.e., driving while not fully awake after ingesting a sedative-hypnotic drug, with no memory of the event), making phone calls, or preparing and eating food, while asleep.

Amnesia

Anterograde amnesia of varying degrees of severity reported following therapeutic doses.a Frequency may be greater with triazolam than with other benzodiazepines.a May be particularly disturbing with triazolam, especially when high doses (e.g., 0.5 mg) are used.

Anterograde amnesia (“traveler’s amnesia”) that occurred upon awakening and persisted for several hours has been reported by individuals who took triazolam to induce sleep while traveling (e.g., during airplane flights).a Concomitant use of alcohol may have been a contributory factor in some cases.a

Bizarre behavior has been associated with the period of amnesia in some patients.

Consider the risk of anterograde amnesia in patients receiving triazolam, particularly when relatively high doses are considered (e.g., for transient insomnia associated with sleep-wake schedule changes) or when the duration of drug effect is likely to exceed the intended period of sleep (e.g., when taken to induce sleep while traveling).

CNS Depression

Performance of activities requiring mental alertness and physical coordination may be impaired.ab

Concurrent use of other CNS depressants may potentiate CNS depression.ab (See Specific Drugs and Foods under Interactions.)

Dependence and Abuse Potential

Psychologic and physical dependence may occur following prolonged use.ac

Patients with a history of drug or alcohol dependence or abuse are at risk of habituation or dependence; use only with careful surveillance in such patients.a

Tolerance and Withdrawal Effects

Tolerance and adaptation to the hypnotic effect may occur after several weeks of therapy, resulting in diminished effectiveness during the end of each night’s use (early morning insomnia) and, possibly, increased daytime anxiety.

Increase in daytime anxiety reported after as few as 10 days of continuous use; daytime anxiety also may occur between nightly doses as a manifestation of interdose withdrawal.a If increased daytime anxiety occurs, discontinuance may be advisable.a

Potential for rebound insomnia for 1 or 2 nights after drug discontinuance.a

Rapid dosage reduction or abrupt discontinuance may result in signs and symptoms of withdrawal (similar to barbiturates or alcohol).ac

Interactions

Concomitant use with drugs that are potent inhibitors of CYP3A (e.g., itraconazole, ketoconazole, nefazodone, delavirdine, efavirenz, HIV protease inhibitors) is contraindicated.130131132133134135136137138139140141a Less potent inhibitors of CYP3A should be used concomitantly with caution; consider possible need for reduction of triazolam dosage.a (See Interactions.)

Sensitivity Reactions

Potential risk of anaphylaxis and angioedema; may occur even with the first dose of drug.

General Precautions

Suicide

Use with caution in depressed patients; potential for suicidal tendencies.a Prescribe and dispense drug in the smallest feasible quantity.ab

Lactation

Pediatric Use

Geriatric Use

Increased sensitivity to dose-related adverse effects.100121 Clearance is reduced and plasma concentrations are increased by about 50%.a Use reduced dosages (see Geriatric or Debilitated Patients under Dosage and Administration); use the smallest effective dose.a

Half-life

Special Populations

Stability

Storage

Oral

Tablets

Actions

Effects appear to be mediated through the inhibitory neurotransmitter GABA; the sites and mechanisms of action within the CNS appear to involve a macromolecular complex (GABAA-receptor-chloride ionophore complex) that includes GABAA receptors, high-affinity benzodiazepine receptors, and chloride channels.

Advice to Patients

Provide patient with a copy of the manufacturer's patient information.a

Importance of taking only as prescribed; do not increase dosage or duration of therapy unless otherwise instructed by a clinician.a

Importance of informing clinicians of any behavioral or mental changes, memory impairment, tolerance, or dependence/withdrawal symptoms.a

Importance of taking only when able to get a full night’s sleep (i.e., 7–8 hours) before being active again.a

Potential for drug to impair mental alertness or physical coordination; use caution when operating machinery or performing hazardous tasks until effects on individual are known.a

Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, and of concomitant illnesses, particularly depression.a

Importance of women informing their clinician if they are or plan to become pregnant or to breast-feed; necessity for clinicians to advise women to avoid pregnancy during therapy.a

Importance of informing patients of other important precautionary information.a (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Subject to control under the Federal Controlled Substances Act of 1970 as a schedule IV (C-IV) drug.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Triazolam

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

0.125 mg*

Halcion (C-IV)

Pfizer

0.25 mg*

Halcion (C-IV; scored)

Pfizer

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

141. Panel on Clinical Practices for Treatment of HIV Infection of the Department of Health and Human Services (DHHS). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents (October 10, 2006). From the US Department of Health and Human Services HIV/AIDS Information Services (AIDSinfo) website ().

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